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October 10, 2024

LCD and Policy Article Revisions Summary for October 17, 2024

Joint DME MAC Publication

Outlined below are the principal changes to the DME MAC Local Coverage Determinations (LCDs) and Policy Articles (PAs) that have been revised and posted. The policies included are External Infusion Pumps, Glucose Monitors, High Frequency Chest Wall Oscillation Devices, Knee Orthoses, Speech Generating Devices (SGD) and Wheelchair Seating. Please review the entire LCDs and related PAs for complete information.

External Infusion Pumps

LCD

External Infusion Pumps LCDExternal Website

Revision Effective Date: 10/01/2024

HCPCS CODES:

  • Removed: Code J1170 from Group 4 Codes
  • Added: Code J1171 to Group 4 Codes

10/17/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

Glucose Monitors

LCD

Glucose Monitors LCDExternal Website

Revision Effective Date: 10/01/2024

HCPCS CODES:

  • Revised: Long descriptor for HCPCS code A4271 in Group 2 Codes

10/17/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Glucose Monitors PAExternal Website

Revision Effective Date: 10/01/2024

CODING GUIDELINES:

  • Revised: Coding guideline information for HCPCS code A4271

10/17/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

High Frequency Chest Wall Oscillation Devices

PA

High Frequency Chest Wall Oscillation Devices PAExternal Website

Revision Effective Date: 10/17/2024

ICD-10-CM CODES THAT SUPORT MEDICAL NECESSITY:

  • Added: ICD-10-CM codes E74.02, E74.05, G72.49, and G72.9 to Group 1 Codes

10/17/2024: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Knee Orthoses

LCD

Knee Orthoses LCDExternal Website

Revision Effective Date: 10/01/2024

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: Code L1821 to prefabricated knee orthoses
  • Added: A row to the prefabricated knee orthoses table that contains base codes and addition codes that are not eligible for separate payment; this added row contains "L1821" as the Base Code and "None" in regard to Addition Codes – Eligible for Separate Payment
  • Added: A row to the prefabricated knee orthoses table that contains base codes and addition codes which can be physically incorporated into the base orthosis but that are not considered reasonable and necessary; this added row contains "L1821" as the Base Code and "L2397" as the Addition Codes – Not Reasonable and Necessary

HCPCS CODES:

  • Revised: Long descriptor for code L1820 in Group 1 Codes
  • Added: Code L1821 to Group 1 Codes

10/17/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Knee Orthoses PAExternal Website

Revision Effective Date: 10/01/2024

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Code L1821 to the referenced prefabricated orthoses

CODING GUIDELINES:

  • Added: A row to the table that pertains to corresponding sets of HCPCS codes; the added row contains "L1820" in Column I and "L1821" in Column II
  • Revised: Long descriptor for HCPCS code L1820
  • Added: Coding guideline information for code L1821
  • Added: A row to the prefabricated knee orthoses table that contains base codes and addition codes that describe components or features that can be physically incorporated into the base orthosis but that are considered to be included in the allowance for the orthosis; the added row contains "L1821" as the Base Code and "L2390, L2750, L2780, L2810, L4002" as the Addition Codes – Not Separately Payable
  • Added: A row to the chart that reflects the reasonable useful lifetime of prefabricated knee orthoses; the row includes "L1821" as the Code and "1 Year" as the Reasonable Useful Lifetime

10/17/2024: At this time 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Speech Generating Devices (SGD)

LCD

Speech Generating Devices (SGD) LCDExternal Website

Revision Effective Date: 10/01/2024

COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY:

  • Added: "electromyographic sensor" to the accessories noted as covered when furnished to individuals with a demonstrated medical need for such accessories

HCPCS CODES:

  • Added: Code E2513 to Group 1 Codes

10/17/2024: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because the revisions are non-discretionary updates per CMS HCPCS coding determinations.

PA

Speech Generating Devices (SGD) PAExternal Website

Revision Effective Date: 10/01/2024

POLICY SPECIFIC DOCUMENTATION REQUIREMENTS:

  • Added: Code E2513 to billing information
  • Added: "Additionally, claims for HCPCS code E2599 must include the supplier price list (PL) amount." to billing information, as clarification

MODIFIERS:

  • Added: "E2513" to the HCPCS codes that require KX if all the coverage criteria are met
  • Added: "E2513" to the HCPCS codes for which claim lines billed without a KX, GA, or GZ modifier will be rejected as missing information

CODING GUIDELINES:

Revised: Information pertaining to methods of device access permitted by E2510, to include "electromyographic sensor" in the indirect selection techniques

  • Added: Coding guideline information for code E2513

10/17/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Wheelchair Seating

PA

Wheelchair Seating PAExternal Website

Revision Effective Date: 10/17/2024

ICD-10-CM CODES THAT SUPPORT MEDICAL NECESSITY:

  • Added: ICD-10-CM code G72.41 to Group 2 and Group 4 Codes

10/17/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Note: The information contained in this article is only a summary of revisions to the LCDs and/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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